Therapeutic alliance relationship

Sometimes you can use your legally mandated course of action to leverage a voluntary admission on the part of a client. If you remind the client that you are now bound to report the incident if she or he is not willing to seek help, then frequently the client will acquiesce and voluntarily seek help. Your responsibility is to make certain that the client actually follows through rather than simply feigning compliance. Obviously this outcome is preferred, since it helps to preserve the therapeutic alliance, whereas an involuntary commitment often harms your relationship with a client. 

Development of a therapeutic relationship The third component of a philosophy of practice states that care is provided by establishing a therapeutic relationship between the patient and practitioner. The term therapeutic relationship has been adapted from the concept of a therapeutic alliance used in the mental health consulting professions. A therapeutic relationship is required to care for another human. 

For many years, the relationship between patient and doctor could be characterised as a therapeutic alliance based on mutual trust (Gutheil et al, 1984). Harmful adverse events have always been possible though, as shown by studies on medical malpractice and negligence (Leape et al, 1991). 

The therapeutic relationship, or more properly, the alliance, is the fundamental dimension of care. Its effectiveness as a separate therapeutic entity has been shown to correlate positively with the accuracy of the intervention itself, the fit of the theoretical approach, and the proper use of particular therapeutic techniques (Crits-Christoph et ah, 1993 Luborsky et ah, 1985). In other words, how clinicians are with their patients is as important as what clinicians do to, or with, their patients. Poor alliances lead to premature termination of care (Magnavita, 1993), just as good ones, in which patients feel understood, lead to far better follow-up and outcome (Zisook et ah, 1978-79). 

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